Refill a prescription

Innovation close to home

After multiple bouts of intestinal bleeding, Gene Baker found relief from innovative treatment at
Sanford Health.

A tumor a little larger than a pencil eraser
eluded doctors for years until a
combination of technologies available at
Sanford Health helped pinpoint the cause of
Gene Baker’s intestinal bleeding.

Baker, 60, first experienced a bout of intestinal
bleeding in 2004. He also began suffering from a
chronic upset stomach that wasn’t relieved by
medication. The bleeding recurred in 2007. Both
times, it resolved itself, and doctors were unable to
determine a cause.

“In January 2010, I had my third episode of
bleeding and went to the Sanford Emergency & Trauma Center,” the Mandan
man said. “If Dr. Renton hadn’t come into the
picture, who knows how long I would have
gone undiagnosed.”

Douglas Renton, MD, Sanford Health
gastroenterologist, first had Baker undergo a scan
that involved tagging his blood with a radioactive
tracer. When that didn’t reveal the problem,
Dr. Renton explored the stomach and colon.
Again, the source was not found.

Next, Dr. Renton used capsule endoscopy to
examine the small bowel.

On a Friday morning, Baker swallowed a vitamin-sized capsule containing a camera and radio transmitter. A miniature computer strapped to his belt collected the images over an eight-hour time span, long enough for the capsule to travel the length of the small bowel.

The following Monday, he had his answer.

The bleeding was from an ulcer on a small tumor located deep inside the small bowel. Next to it was a Meckel’s diverticulum, a pouch on the wall of the small bowel formed from remnant of stomach lining left behind during fetal development.

Treatment had to be delayed for two months, so Baker could complete a
full year of blood thinners required after having a heart stent inserted in 2009.
In April 2010, Dr. Renton performed a single balloon enteroscopy to locate
the mass, biopsy it and mark it with dye for the surgeon to easily find.

For single balloon enteroscopy, a long flexible tube is equipped with a light
and camera at the tip and fitted with an equally long overtube. On the tip of
the overtube is a balloon that can be inflated, anchoring the bowel onto it.
The overtube is pulled back, shortening and straightening the small intestine
to make passage of the inner endoscope easier. Specialized tools are inserted
through the scope.

In some cases, growths can be removed with this procedure. Dr. Renton can also cauterize small collections of blood vessels called arteriovenous malformations, or AVMs, which can cause a patient to have chronic bleeding requiring repeat hospitalization or blood transfusions.

The biopsy confirmed the tumor to be cancerous. Because it was located in
the muscle of the small intestine, Dr. Renton was unable to remove it with the
single balloon enteroscope.

“This type of slow-growing cancerous tumor is very difficult to find,” Dr. Renton said. “When it is located in the small bowel, it is most often found only after it has spread.”

The tumor and the Meckel’s diverticulum were removed through two small
incisions. If the area hadn’t been previously marked, Baker would have
required a large incision through which the surgeon would have searched the
small bowel by hand.

“I was back to my regular routine of walking and exercising within a week
of my surgery,” Baker said. “I no longer have bouts of nausea, and my energy
level has increased.”

Dr. Renton was the first in North Dakota to perform this innovative
procedure.

“This technology allows us to find an explanation to problems that were
very difficult to determine in the past,” Dr. Renton said. “Because it is
available at Sanford Health, patients can avoid traveling to Rochester or
Minneapolis for this type of care.”

Baker underwent a scan two weeks after surgery, and no evidence of
cancer was found. He will continue the annual scans for two more years.
“I’m so thankful to Dr. Renton,” Baker said. “It was my luck in getting him
as my doctor and his persistence that found the tumor.”